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Life-changing moment

National award recipient tells story of the moment she knew palliative care would be her life's work

Teaching and Learning

By Michelle Osmond

Dr. Susan MacDonald is a palliative care pioneer in Newfoundland and Labrador.

It’s been her passion since she was a medical intern and it has not wavered, even decades later as she continues to teach future physicians about the importance of taking care of the dying.

That passion was recently recognized by the Canadian Association for Medical Education (CAME) with its 2020 Certificate of Merit, an award that promotes, recognizes and rewards faculty committed to medical education in Canadian medical schools.

“It’s not a chore to do this, it’s an honour.” — Dr. Susan MacDonald

Dr. MacDonald, an associate professor of medicine and family medicine, appreciates the confirmation from her peers, students and organizations like CAME saying it reaffirms that the effort of constantly trying to do your best for patients and for those you teach is worth it.

“My work is all about hope.Helping people find hope when there doesn’t seem to be any,” she said. “My educational work is helping students and colleagues realize that there is hope for their palliative patients and empowering them to be able to provide it. It’s not a chore to do this, it’s an honour.”

Dr. Susan MacDonald has dedicated her career to caring for the dying.
Photo: Richard Blenkinsopp

The moment it changed

Below, Dr. MacDonald tells the story of the moment palliative care became her life’s work in her own words.

“Not everyone can point to the exact moment when their career became crystal clear and they knew exactly what they were going to do with their life. But I do.

“I was an intern. Just a couple of months into my first six-month rotation on internal medicine. I was on call and paged to the emergency room. A frail, unconscious woman lay on a gurney. She was so tiny I could barely see her under the mound of blankets. Her daughters flanked the bed. Their mother was in her late 80s and had lived a long and productive life. Her last several years had been plagued with debilitating Parkinson’s disease and that day she’d had her third major stroke. She was unconscious and waiting for the end. Her daughters wished a peaceful death. It sounded reasonable to me. I wrote orders for comfort and arranged a quiet room upstairs, and without another thought headed to the next clinical situation.

“The next morning on rounds I presented the case to my attending physician. He thumbed through the chart as I talked. When I finished and had summarized my plan of care, he looked up at me and spoke. “She has an elevated potassium.” Well, yes, I’d noted her abnormal bloodwork in the emergency room, but there was nothing there I thought worth treating. The woman was dying. I asked how further tests and treatments would help. He responded: “No patient dies with an elevated potassium on my service.”

“Those were the words that changed my life.

“His words were final. Pleading and arguing wouldn’t change his mind. Those words meant that I had to change the orders for my patient. That I had to assault her with medicated enemas and frequent stabs for blood until her potassium came down to normal levels. Then, and only then, could I let her die. I felt bitter and angry and impotent. I felt that I had betrayed that woman and her daughters. And I swore I would never do that again.

“It’s been my life’s work to prevent that scenario from repeating. My work to learn enough so that I had facts and science behind my decisions. That I could justify my actions to those who disagreed. My work to teach everyone how to care for the dying. So that every nurse, every physician, every allied health member would be “on my team” and supporting the care for the dying. My work to advocate for those who have no voice.”

Adjusting to the new normal

During the pandemic, Dr. MacDonald has focused on providing care to her patients, who are among the most vulnerable people in the province, while working around the restrictions that COVID-19 has placed on everyone.

Virtual education has been a challenge, she says, to create a series of recorded lectures that “don’t put the poor students to sleep!”

“I have so much fun in class, telling stories, engaging in dialogue and learning from my students, that virtual teaching has been a real loss for me. However, I’m doing my best to be creative.”

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